Somewhere between writing and doctoring.

Musings

I have been asked the question, several times, ‘why did you set a novel about medical error up in Wittenoom?’ It’s a fair question really.

I have to answer this a little blind. Most novels arise from some odd place; they spill forth from the subconscious organ, wherever that is. Brain? Behind the spleen? Who knows. As most neuroscientists admit, we do not understand the creative process in the slightest.

All I knew is that a mistake I had made in the infancy of my career had stayed; fashioned itself into something solid, grew a little bit each year, beyond all the other mistakes, and started courting words. It wanted to be written.

So we faced the blank page, me and my brain, not really having any idea how to do this novel-writing business, and began. And the moment I did, needing to send my fallen doctor, somebody who had made an unforgivable mistake and was slowly dissolving in the acid of her own contempt, somewhere, the image of the abandoned, ruined hospital of Wittenoom flared true and bright in my head.

I’d travelled to that far-flung ghost town, which stayed clawing on for life with talons of ego and madness, battling all attempts by the Government to shush it out of existence, when I was a soft, unscarred intern. I had found myself alone and lost in the crumbling wreck of the hospital, the walls falling down, but gauze still on the floor and journals stacked and waterlogged in the corner. It was the strangest place I had ever seen. Eerie beyond imagining. The bricks from the walls were toppling, perhaps releasing the ghosts trapped in there, one by one. Relics of equipment were untouched, covered in dust. Dingoes howled nearby. Asbestos fibres floated in on the desert breeze.

But, life needed to move on. I shifted back down to Perth, and folded away anything that was not needed to survive a lifetime trying to become an Emergency Physician. However, when the book began to wriggle out of me, here it was. This hospital. This image. This place. And with this came the research. Which is why Dustfall came to be about the story of a brutal chapter in Western Australia’s history, but even more so, the story of the contempt that some corporations and Governments have for human life. The victims, the dead, those who suffered at the hands of others, they deserved a voice. It was a tough book to write, but through the extraordinary help of others, it is now on paper. In stores. People occasionally read it, and for every soul that takes the time to do so, I will never be able to express the extent of my gratitude.

I’m also asked, once in a while, whether the process was cathartic. Well here’s the bad bit. Right now, I’m not entirely sure whether I have survived. At the moment I’m taking a few months away from the hospital. Away from Emergency Medicine. God, I hear you say, not another one.

I don’t particularly want to write about this blindsiding vulnerability – (oh how wonderful is it to appear invincible, in control, untouchable) – but, I am a writer, and the only way I can truly think is with these things; these words, sentences, thoughts, coming from my fingertips.

After all this time, to feel a tiny bit broken, feels the truest kind of failure. We hear a lot about failure – how it is the only way to learn, how it allows us to rise up and grow, like we are some kind of gaseous villain in a superhero movie. But I’m not sure it’s always like that. For some, it’s a pervasive, long term ‘not good enough.’

Medicine, we are beginning to learn, has been a powerful force amplifying that message. You are not good enough.

The compassion equation no longer adds up. While we know that we must reach deep, every single day, into our well of compassion to be half-decent clinicians, the same cannot always be said for those who stand over us, with their administrative roles and executive titles. An unexpected culture of mutual disrespect and suspicion about motives has somehow infested many of these relationships, and it is not clear how to find our way out.

We know the health dollar is limited. We know that agitating for individuals is sometimes at cross-purposes to the greater good when it comes to budgetary allocation. We know we must work to make our systems as efficient as possible. But to come away believing that one’s efforts are not good enough, is, over time, damaging.

I am no stranger to the not good enough mantra. I am, after all, female. I see the same wounds from the same words in others – people whose first language is not English, in the voices of our First Nations people whose lives intersect mine, those with illness/disability. Not good enough. For what, one could rightly ask? Who knows, but we have a society that, more and more, seems to enjoy empowering the voices of the strong – those who feel entitled to make others whisper such words to themselves. Have current global events contributed to this anti-mantra? Where oppression of any voice other than that of wealthy white people goes unfettered? I would like to say wealthy, white men, as it mostly is, although it seems to be the first two adjectives that appear the most in this picture.

I’m not good enough on social media. I’m a fool, at my age, to even care. But I do. I see all the things I should be doing, particularly in critical care, to be a decent clinician, and I know I can never be that person. Why am I not that person, I ask? I also watch the mob-think, the pile-ons, people tossed into the colosseum, and I sit back, aghast. What have we unleashed?

But then, as I look outwards for reasons why I’m sitting here, writing this, I wonder, is the enemy simply inside myself? Am I the cruel prison-guard of my own bruised worth?

There is, though, something rotten going on outside.

When I started writing Dustfall it was 2011. I thought I was writing something historical. That crushing individuals who are on the lower end of the power relationship see-saw was slowly becoming a thing of the past. The world was progressing. Tolerance, globalism, respect, although moving in fits and starts, was heading in the right direction. But I look at our planet now and wonder. I look as countries leak refugees, the result of war-loving men who wear their murderous decisions like epaulettes, the millions affected fleeing to countries which lock up wide-eyed children or push their boats away hoping they might silently drown. ‘Jobs’ trumps climate change, coin beats species loss, tourism beats Indigenous treaties. Women are not believed, lies from the top are.

What are we doing wrong? How do we fix it? Apart from trying to keep a tiny beacon alight, trying to show others the respect you believe is fundamental to our connectedness as humans, I’m not sure. Maybe this is my only advice. If you’re feeling not good enough, then chances are somebody else is too. And those personal connections, not advertised, not instagrammed, where you find yourself in the company of trust and respect, are kind of amazing. And if all else fails, write.

(as a post script, in the light of the inconceivable horrors going on in the US – just for one example, the slaughter of peace-loving Jewish people in their synagogue during a baby naming ceremony – I am re-reading Primo Levi’s If This is a Man. I needed some perspective on the world. What is a man, indeed? I highly recommend it.)

Plus – on the topic of ‘not good enough’, a recent post by the beautiful Shahina Braganza https://shahinabraganza.com/blog/wellness/was-i-enough/

Books find their way into your life by all sorts of means. Often they’re bought, or borrowed, or picked up from somewhere unremembered. The unforgettable ones then find their way into you. A novel read is more than just a story consumed, pages turned, characters met. Each time I read a good book it somehow steals off the page into my molecular makeup. I may not always remember their details, but it is as though with each memorable book I am laying down bricks, one by one, building a slow Taj Mahal of experience. It means this lamentable little body can be so much more than just me.

My little ‘books of 2018’ series celebrates these ones that have, indeed, become part of me. So to Louise Allan’s The Sisters’ Song. This book feels as much part of me as my own. Louise and I were in a writing trio while both of our manuscripts were emerging from the swamp. We worked on them at the same time, sending each other (along with our third member, GP and writer Dr Jacquie Garton Smith) snippets: long and short, wordy and clipped, drafts and outlines. We took wrong turns together and rescued one another from the mire.

I learnt a lot from seeing Louise struggle with her manuscript – as much as I learnt from my own rejections and failures and dispiriting tussles with this process which seemed overwhelming at times. In Louise’s book I was witness to the characters’ evolution, watching them come into their own and stake their claim in the world of literature. I was also party to the improvements and momentum, from a shortlisting in the TAG Hungerford award, to a contract with a large commercial publisher.

And thus The Sisters’ Song was born. It is a book both contemporary and historical. Its themes are universal – women’s lives thwarted by the expectations of both society and their own selves. Louise examines the relationships within families and within marriages, fraught all of them, with painstaking care. Early 20th century Tasmania is evoked with exquisite detail, and the lives of the characters are incredibly well, and beautifully sketched out. Louise’s book is officially a bestseller. Its gentle themes and questions have resonated with the reading public, and it has sold incredibly well. Louise is also a great supporter of other writers, both emerging and established, and she deserves her place in the canon of Australian literature.

It has been an honour and a saviour having Louise for a writing buddy. Our styles are distinctly different, but that does not mean we haven’t been able to offer one another what we both desperately needed to turn our manuscripts from nonsensical early drafts, into completed books.

The year will soon be thinking about folding away its linen, packing up and preparing to roll out its credits. It’s been a bit of a one really. Awful in many ways: cruel, fetid, tribal, amoral. But amongst all of this there has been, as always, beauty, hope, joy, amazement. And, of course, as the flapping banderoles of the latter, there are books.

I’m a terrible blogger; a hopeless archivist. I’ve read many, many books this year, and haven’t always shouted into the ether my thanks to those who’ve slaved over their creation. I know how hard it is to produce a book. I understand the fragility of releasing one. I appreciate what it means to have one’s book connect with a single other human.

So this tiny, likely unread, series, is to give name to the top 12 books that have regaled me with their words this year – those books that have given me delight and elation and rapture and that have, for many reasons, entered my heart. Books do that, you see. Become part of your being, your memory, your DNA, your circuitry, your life.

Each one of these books have given me something precious in their own way. They have slung shot me further along this business of existence, and made me happy that I’m part of it, this writerly, readerly life.

One a week, until 2018 properly shuts down, twelve books for which I am grateful.

BOOK 1

THE EVERLASTING SUNDAY, Robert Lukins.

It was odd reading Robert’s book. We released our debut novels at pretty much the same time. What, I wondered, would happen if they were both really similar? University press, unknown writers, not overly fitting into any pigeonholes, what if they were cut from the same pattern? Reader, they were not.

The Everlasting Sunday is a trip and a half. It is unsettling and dizzying and downright extraordinary. Set somewhere Englishy, boarding house lonely and snowy, it is never quite real, but never unbelievable. It is the Lord of the Flies I always wanted to read. Robert’s writing is magic; every sentence crafted with intelligence and fierce control. I was immersed from the first page, and found it difficult to crawl out of a night. His language slows my heart down, his prose divine.

Somewhere in this is a bit of strange pride that I get to call Robert my contemporary. Perhaps it is more simply contemporaneous, but whatever it is, I feel a tiny kinship with the release of this book. I still see the falling flakes on the front cover, lit up from within, floating to the ground. I can feel the disconnection of the boys in Godwin Manor. I celebrate Robert’s masterful ability. It was the perfect novel to read when I was lost thinking about my own creeping out into the world.

Deeply excited to know what is coming next for Mr Robert Lukins. And if he doesn’t hurry up I shall need to go back and read this one again.

I’m sitting in a narrow nook in the hospital library, all clandestine and covert. I come here far more often than I ought. Today I have this short, sighing reprieve, between teaching registrars in the morning and donning the top hat and whip to command the chaos of the circus until midnight smiles at me, telling me I can exhale and go home. So, like I frequently do, I have sidled into a mysterious corner among bookish shelves and musty journals and ghosts and flickering fluorescent lights. (I am not joking about the ghost. She will, however, have to be the subject of a latter post). Libraries are my oasis, my nirvana, my refuge, my asylum. They are the tents in my desert on a warm autumn evening with mint tea and breeze and the smell of cinnamon and honey.

I should, of course, be doing something sensible. I should be reading journal articles about ventriculo-peritoneal shunt complications, or doing my outstanding (and do please use this word in the pejorative, not the complimentary sense) online training modules, or reviewing some audit material or some-such. But, and this may surprise some of you, I am not.

My preference is to write a love letter. A missive of love, of admiration, of respect. I have just purchased, and am eating, chocolate (wholesome individual that I am) (and it’s the cheap purpley kind, too), which I have purchased from one of the seven wonders of the world (well, my list of them anyway). The volunteer ladies at the lolly shop.

Now I work in a place that’s full of good people. Very good people. Doctors and nurses and physios and orderlies and social workers, all doing the right thing, caring for humanity and all its faces, giving of themselves, supporting others, and, once in the bluest of blue moons, saving a life. But all of us have nothing on the volunteers.

These ladies, for they are all ladies, turn up every, single day. They are never paid. Their roles are legion. They meet and greet (they’ve managed to win the war against the machines installed to give directions at the swipe of a finger, for those who’ve been following this saga. Take that, Singularity), they trundle through the wards with a trolley full of Dan Brown novels and magazines about crocheting and celebrity scandals, they answer any questions from the lost and weary and damned that limp though the corridors, and best of all, they man the lolly shop. They are the most generous, Marcel-waved, wrinkly, powder-dusted, starchy pinafored, pieces of magnificence I’ve ever come across. Full of smiles and chatter and happiness whilst holding an abacus full of wizardly difficult addition in their heads. It is a beauty beyond compare. It is benevolence in human form, altruism covered in skin. Goodness and munificence and bounty. The rest of us are phoning up HR if our pay is 2 hours under and moaning about, well, pretty much everything, and these gorgeous elderly bunnies are helping the swearing homeless man who smells of last week’s urine choose his cadbury bar.

I am buoyed every time I interact with these marvels. There is one who holds a special place in my heart. She stops me each time we cross paths. She wants my help so that she can donate a kidney. She’s been rejected already, and thinks I, in my exalted position, might be able to help her sway the authorities (as though an impassioned speech might persuade those making such decisions that her presumably ailing nephrons promise to behave if she were chosen from the crowd, like a Tribute). I make half-hearted attempts to explain the difficulties, but then usually slope off, making promises I can’t keep. I love her. I truly do. She has told me there’s not much left in her life, and her god wants her to do this one last thing, to help someone else. It is my destiny, she says.

So many others have rich, worthy stories teeming under their creases and crinkles. And they have lives and families, overdue naps, movies to be seen, days left that may be so few they have numbers assigned to them, yet here they are, selling me snacks and sharing their light with this small world.

And, with this post, my time is up. My break is done, and my loins must be frantically girded, as I must brave the floor. I’ve done no work here, but I’ve given my words back to the ladies who’ve given so much to me. Thank you LOLs.

(PS the image is my view right now. OK, a bit of a stretch to the lyrical flapping tent in the cool desert wind, but still.)

This is a post that has had many years to brew. There is much I want to say – there are vast reams of words and shouts and polemics with which I’d love to spray paint the page. But I shall test my embryonic writerly skills, and see if I can keep it short. Succinct. Meaningful.

I’m off twitter for a day. In the swirling wake of rage following the outing of Harvey Weinstein, there has been a twitter response: #WomenBoycottTwitter. While I am under no illusion that this will change a thing (in fact the choice of silence as a protest when silence has been the age-old problem feels incongruent), and it may seem like somewhat of a pointless exercise, I choose to join with women who believe it to be important. I am part of the sisterhood.

I am an Emergency Physician. I have worked for decades in a sweaty, high-stress, muscly environment, requiring skills that may be considered kind of masculine. Control, a firm voice, a steely resolve, and an ability to suck up the bad stuff and just carry on. For most of my career I have considered myself oddly genderless. It is not infrequently I am asked what it is like to be a woman in this world. For years though, I have made a conscious decision that this is an issue I do not want to talk, or write, or speak on stage about. I have wanted, for my entire career, to make my beliefs and ideology known by doing. The ultimate ‘show don’t tell.’ I have tried to be the best role model I can, in my own messy, fallible way, so that every woman (and man) behind me will be supported and valued in their lives of critical care, and to see that it’s OK to achieve quietly. I hope, after this tiny, inconsequential post, I shall go back to doing the same.

The reason, however, that I am breaking this personal reticence, is that occasionally silence equals complicity. The silence of those in Hollywood, and on the other side the silence of the generations of women who knew they’d be pilloried, disbelieved, or worse, if they spoke out. Silence, truly, in this day and age, is not a valid option. I also choose not to be silent about Australia’s inhuman treatment of refugees, or the world’s entrenched racism, or that appalling man on his gaudy golden throne across the ocean, legitimising all that is bad on this planet.

I am also deeply fortunate that I work, and am surrounded by, good men. I see and interact with them everywhere, and admire their moral fibre, their considered intelligence, their respectfulness, and I am grateful for being among them. I am also aware that there are other voiceless people oppressed by those more powerful – many of the former being men, people of colour, and our LGBTQI community, and as such singling a group out, above the others, has always felt wrong.

Almost as an aside, I have also suffered sexual harassment, as well as sexual assault. These are certainly things that mark you forever, change how you feel about yourself, crush a part of you, damage you, strip you of confidence. Now I am (trying to be) a grown-up, I have no more need to delve into those times. Now is my time to extend the hand of love to those behind me.

I stand up for every person who is crushed by someone of power above them. I stand alongside all women, and I believe you. I intend to live my life in a way that honours and supports anybody who does not have the means to do that for themselves. I am a feminist, and this is my version.

I’ve just been driving on the little artery connecting Perth with ‘down South’ (the only holiday destination a drivable distance for we people in this sorrowfully isolated city, a refuge to which the townies escape in order to furiously recreate). The road is in jolly good nick, hugging the coast as it does, and it bypasses the bristling little towns on the way. It’s very different from driving the mean-looking Albany highway, which is straight as a Cormac McCarthy sentence, and bisects off the juicy little south-west triangle, dividing southern Western Australia into the haves and the have-nots – a partition between green and brown, grapes and wheat, money and not, leisure and work.

Anyway, heading southwards, I saw a man riding a motorbike. He was dressed from top to toe in the richest of browns, copper coloured corduroy pants, a brownish khaki shirt, nut-coloured shoes and an open faced helmet, and he was riding a Royal Enfield – a majestic thing on two wheels, all elegance and history. He rode it slung back in his seat, and, with the entire horizon steeped in smoke from some distant bushfire, as he passed I could taste adventure. Smell the exploits ahead of him. In the lane next to him was a brown volvo – actually more beige, the colour of slacks that men of a certain age wear to their Rotary meetings. And in that car, was me. And a song played over in my head. How did I get here? This is not my beautiful life.

Back in university days, when ‘down South’ was the only vacation option for the cash-strapped and unimaginative among us, when our thighs were hard-muscled and our cars were borrowed, we would stay in makeshift campsites, or the friend of a friend’s beach shack, and play drinking games nobody really knew the rules of, our only bath the icy washing machine of the Indian Ocean.

But now, in the mesmerising drive down to the ‘resort’ where we are booked for a few days, I had plenty of time to reminisce, compare the then and the now. The road, of course, was full of visual distractions, little snippets that make this drive so unique. I saw a fully assembled drum kit being played next to a rubbish bin in one of the truck lay offs, genderless youths in black hoodies hurling rocks at birds, boxes of squashed end of season fruit advertised for sale for the price of a gold coin, and the repeated lonely little crosses by the roadside, covered in their colourful synthetic flowers, paying stoic homage to our national pastime of slaughtering our young on our roads.

Before I knew it though, before I could descend into too much maudlin memory and regret, I arrived at the main hub of this holiday destination, this odd place of perhaps the undeservedly rich. It’s got itself a bit of a bad rap, this town, as though it were the Hamptons misplaced, Gatsby’s West Egg without the glitz, the cafes with their queues of people as impatient here as they are in high street Claremont, their annoyances simply transplanted along with their neighbours, every bank holiday weekend. Not unaware of my own hypocrisy, we trooped into our own bungalow with its gleaming marble basins and hand lotions arranged just so.

I haven’t done this place justice though. The southern coast of Western Australia has far more exquisite beauty than it does plastic pop-ups. It is mostly ancient and wild and has air full of fresh, screaming wind, and more biodiversity than we paltry humans have any idea about.

And as we pulled into our home for the next few days, I saw, for a brief moment, simultaneously, the setting sun – a burnished bronzed orb, alchemically distorted by the smoke – and on the other horizon a warm, full moon, so clear you could see the valleys and rifts and seas upon it, and for a few minutes they were balanced exactly, as though they were a Calderian sculpture, and I felt such a sense of perfection, such wonder, I was overwhelmed with gratitude that I was right here in this moment, able to see such things, knowing I would never have done so in my unseeing university days. And that I am deeply happy to be the age that I am, and with the words to say so.

I’ve noticed an odd groundward trend, somewhere between the hospital car park and the emergency department. I’ll call it my daily Hansel and Gretel. Always a little different, sometimes it’s just a relic, or a clue, or an odd discarded piece of peculiarity, or, at its best, a good going trail. But there’s always something. Like a treasure map leading into the department, with a tale chasing behind it, these are the things I’ve seen walking into the hospital (and I apologise if you’ve seen these before on my twitter feed. In fact, I feel I ought to apologise to any of you poor things if you’ve read my twitter feed (aside again. Twitter feed. Bird feed. We’ve come full circle here. Back to Hansel and Gretel. Although in the Grimm story the trail led from, or to, a house of cake and confectionary. No amount of imagination will transform our ED such.). ):

Dollops of blood. This was very CSI. Leading from an unassuming bay on the third floor of the car park and punctuated by a hand print and smear down one wall of the stairwell, this didn’t let up until it reached the triage area. Requires the least inventiveness of all to work this one out.

Coffee stains. Much sadder, this one. Somebody spilling precious fluid in an obvious hurry to get into work.

A polystyrene esky, its lid half off, with a peeling Biohazard label on the side. It was, presumably, full of discarded organs, trafficking gone wrong, a bad internet deal. I couldn’t bear to look inside.

Those little cartridges of nitrous oxide, usurped from their respectable role inside canned cream dispensers, they’d been crushed by the hand of somebody seeking cheap oblivion. Laid out like shame.

The most recent, a mass of bloody feathers, arranged with the suggestion of a sacrifice. I pondered on this one the entire day, and by the time I left a rather draining shift, my heart emptied out, I figured it was the remains of Icarus, the last of his singed feathers dropped on our doorstep, to remind us of man’s complacency and hubris.

But it does always make me smile, encountering these trails, the scent of what’s to come for the day. As I dodge the raucous man selling The Big Issue (I find I cannot buy more than two or three copies before I start averting my eyes), the splintering piano in the corridor (frequented at night by lonely patients playing with their gowns gaping open at the back), and the LOLs (the little old ladies – the purple haired volunteers – oh but they are another whole post), I am alway ludicrously cheered and steeled by the time I walk through the sliding doors of the department into the chaos, a place made not of candy and chocolate, but a Grimm tale, all of its own.

Twenty-seven years a doctor and I still haven’t become accustomed to it. I’m not even sure when the exact moment is, that instant of death. Is it the last beat of the heart, or the concluding gasp, or is it the terminal neuron sparking out – the final neurotransmitter molecule crossing the last closing synapse like a desperate man jumping Niagara Falls? What, officially, counts? She was a beautiful old thing – a palace of a woman – her body a castle of stories and history. You could tell by the family, the loving way they held each other round the bedside, that she was a good woman. Had led a worthy life, and her legacy had spread through her progeny with the steady stealth of a slow burning fire.

But still, I found it difficult. I, unlike her beautiful children, had only just met her, a few hours before. She had turned frail with the last season; her lungs had thought about giving up several times in the previous month, and this episode of pneumonia was determined to take her out. At 83, the decision by everybody who hovered over her, to cap care at an agreed upon ceiling, was entirely appropriate. So we all gathered around in a quiet little side room, with not much more than a gentle hiss of oxygen, and some moistening of her lips, to bear witness as she departed.

I watched intently. I don’t often get the chance to do this. Would there be some sign? Something to indicate that a solid, practical, blood circulating life of flesh was changing places with a world inert? Was her life flashing behind those papery thin eyelids with their spidery, barely pulsating veins – an old fashioned silent movie reel? The word spiritual came to mind, but I was no closer to understanding. Whatever time it was, I made note of it in her records. Rest In Peace. And it was peaceful in that room, only a quiet, juddering sob here and there.

The family, all four of the children, hugged me. We’d made all the decisions together; they’d been heard, their mother, and her life – that good one, full of friends and dinners and choir meet ups and laughter – had been respected. The rarity of being thanked, and for letting someone die, stopped my own breath. And then I had to go, because a rhinoceros of a meth-addict was screaming down the corridor just beyond, and something needed to be done.

What a job. What a phenomenal, amazing, heart-breaking, privilege of a thing.